Denver Public Schools Student Intervention Team...

Permission to reprint granted with appropriate acknowledgement ©2009 DPS

Denver Public Schools

Student Intervention Team Problem‐Solving Process

(Adapted from the work of Howell, Patton, Deotte, 2008)


Student Intervention Team Forms Step One: Complete and Submit Initial SIT Referral Form to Initiate SIT Process (page 1). Step Two: Receive Date for SIT Meeting from Committee. Step Three: Send out Parent Letter of Invitation to SIT Meeting (page 2). Step Four: Receive your Assigned Designated Consultant from SIT Committee. Step Five: Complete SIT Body of Evidence Data Collection Process with your Designated

Consultant for Primary Area(s) of Concern (pages 3a, 3b, 3c, and/or 3d).* *For Culturally and Linguistically Diverse Students Complete the Additional Body of

Evidence Data Collection Process (available on SIT website). Step Six: Conduct SIT Meeting Documenting Problem‐Solving Process and Possible

Solutions/Interventions (pages 4a & 4b). Step Seven: Create an Intervention Plan that Includes a Progress Monitoring Plan (page 5). Step Eight: Follow Up Meeting is Held 6 to 9 Weeks from Last SIT Meeting (page 6).

KEY for SIT IKONS

Starting Point to Initiate SIT

Parent Letter (to be sent prior to meeting)

Reading Body of Evidence

Math Body of Evidence

Behavior Body of Evidence

Culturally & Linguistically Diverse Body of Evidence

Meeting Forms (completed during actual SIT meeting)

or or or


Denver Public Schools Initial SIT Referral Form

To be completed by the Referring Person to Initiate a SIT Meeting

Student Name _______________________________________________ Grade______ ID__________ DOB__________

Address ____________________________________________________ Phone_________________________________

Referring Person ________________________________ School_______________________ Date__________________

Please Attach: □ IC Summary □ IC Attendance □ IC Behavior Log/SWIS □ IC Assessment □ IC Grades □ ILP □ IEP □ Report Card □ MyCAP data (High School Only) □ Transcripts (High School Only) □ Work Samples □ Health Plan □ Other Pertinent Document □ Current class schedule

Language Information:Native Language:_____________ Is the student identified as an ELL? Y N What is the student’s current ELA Program? _______________________________ Language of Instruction: Literacy:____________________ Math:______________________ Social Studies:_______________ Science:____________________ Interpreter Needed for Meeting? Y N Language:__________________

Support Services in Place:□ Nurse □ Counselor □ Psychologist/Social Worker □ Speech/Language □ Outside Mental Health Services □ Denver Health □ Drug/Alcohol Counseling □ OT/PT □ Tutoring □ Hearing/Vision

Pass/Fail Date_______ □ Other:__________________

Areas of Concern: (Please Check)

Reading: English L1

Phonemic Awareness Phonics Fluency Vocabulary Comprehension Application/Analysis/Synthesis/Evaluation

Written Language: English L1 Grammar/Usage/Sentence Structure Capitalization/Punctuation Spelling Style and Fluency Voice Organization Ideas and Content

Oral Language: English L1 Articulation (Intelligibility) Receptive Language (Comprehension) Expressive Language

Mathematics: English L1

Number Sense Algebraic Thinking Data and Probability Geometry Measurement Computation

Motor: Gross Motor Fine Motor

Health: □ Vision □ Hearing □ Dental □ Mental Health □ Other:_______________

□ Attendance/Tardiness Data: __________________

Social/Emotional Learning: □ Following Classroom Rules □ Responding to Redirection □ Working in a Group □ Interacting with Adults □ Interacting with Peers □ Participating in Class Discussions □ Asking Appropriate Questions □ Motivation to Learn □ Quality of Work □ Persistence w/Difficult Tasks □ Difficulty with Transitions □ Staying on Task □ Completing Homework □ Finishing Work on Time □ Taking Care of Materials □ Paying Attention in Class □ Following Directions □ Poor Study or Organization Skills

Specific and observable description of student strengths: ______________________________________________________________________________________________________________________________________________________________________________________________

Specific, observable, and measurable description of the most concerning problem: ______________________________________________________________________________________________________________________________________________________________________________________________ Parent Contacted: (Parent contact is required prior to assignment of Designated Consultant)

Date: _________________ Parent Response: _________________________________________________________

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Denver Public Schools Letter of Invitation to SIT Meeting

Student’s Name: Student ID #: Date of Birth: Grade: School: Date:

Dear Parent or Guardian,

As we discussed, ______________________ has been referred for a Student Intervention Team (SIT) meeting. During this meeting we will discuss your student’s strengths and needs, and develop a support plan. Your support and assistance are essential to your student’s success in school. We look forward to meeting with you.

Specific Area of Concern:

The meeting is scheduled for:

Date: _________________ Time:__________ School:_________________________ Room:__________

If you have any questions or concerns, or need to reschedule, please contact:

Name:_______________________________________________

Phone Number: ____________________________________

Sincerely,

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Denver Public Schools SIT Body of Evidence for Mathematics

To be completed by the Designated Consultant and the Classroom Teacher

Student Name: _________________________________________ Grade: _____________ID: ____________ DOB:____________

Referring Person: __________________________________________________ Date: __________________________________ What is the problem? Please identify/attach all applicable data.

Math Standards Proficiency (U, PP, P, or A)

Number Sense: ____ Algebraic Thinking: ____ Data & Probability: ____ Geometry: ____ Measurement: ____ Computation: _____

Classroom Assessment data ‐ Ongoing (anecdotal records, observations) Product (student work), Periodic (formal assessment, quizzes, unit tests):

State/District Assessment data (CSAP, DPS Benchmark, CBMs, etc.)

Progress Monitoring data: Assessment Tool:___________________________________________________________________________ Outcome Goal: ____________________________________________________________________________ Date/Data: _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ Assessment Tool: __________________________________________________________________________ Outcome Goal: ____________________________________________________________________________ Date/Data: _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ Targeted Assessment data (if administered):

Area of Strength:

Most Significant Concern:

How does data compare to classroom peers?

Intervention Checklist:

Accommodations:

□ Use of manipulatives □ Additional Time □ Frequent Checks □ Extended Practice □ Provided Resources □ Allow use of Calculator □ Frequent Feedback □ Break down Tasks □ _____________________

Research Based Interventions:

Name:

Duration:

Intensity: Group Size: Results:

Please attach (if appropriate):

□ Evidence and outcomes of all accommodations

□ Progress Monitoring Graphs □ Assessment Information □ Classroom Observations □ IC Data □ Work Samples □ Other Important Data

3a


Denver Public Schools SIT Body of Evidence for Literacy

To be completed by the Designated Consultant and Classroom Teacher

Student Name: ________________________________Grade: _____ ID: ________ DOB: __________ Referring Person: ____________________________________ Date: _______________________

What is the concern? Please attach ILP and all applicable data (complete information below ONLY if not reflected on ILP). Classroom Assessment Data: (eg. student work, observations, anecdotal information, classroom tests, attendance) State/District Assessment Data: CSAP: CELA: DPS Benchmark: SRI: DRA 2/EDL: DIBELS/AIMSweb Benchmark: Other: IDEL/MIDE: Targeted Assessment Data: (e.g. phonics survey, spelling inventory) Progress Monitoring Data: Assessment Tool:___________________________________________________________________________ Outcome Goal: ____________________________________________________________________________ Date/Data: _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ Assessment Tool: __________________________________________________________________________ Outcome Goal: ____________________________________________________________________________ Date/Data: _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ Areas of Strength: Most Significant Concern: How does data compare to class peers? Accommodations: □ Multi‐sensory Strategies □ Additional Time □ Frequent Checks □ Additional Practice □ Seating Change □ Timer □ Frequent Checks for

Understanding □ Decodable Phonics □ Fluency/Speed Drills □ Other: _______________________

Research Based Interventions:Name: Duration: Intensity: Group Size: Results:

Attach if Appropriate: □ ILP □ Evidence and outcomes of all

accommodations □ Progress Monitoring Charts □ Assessment Information □ Classroom Observations □ IC Data □ Work Samples □ Other Pertinent Data:

____________________________ ____________________________

3b


Denver Public Schools SIT Body of Evidence for Social‐Emotional Learning

To be completed by the Designated Consultant and the Classroom Teacher

Student Name: _________________________________ Grade: ________ ID: __________ Date: _________ Referring Person: ____________________________________________ Date: _______________

What is the problem? Please identify/attach all applicable data.

Does the student have a medical diagnosis? Y N Explain:

Targeted Assessment data (if administered):

SIEVE: ________________________________________________ BASC- 2: __________________________________________________________

Attention: ______________________________________________ Adaptive: ________________________________________________________

Other: _________________________________________________ Observation: _____________________________________________________

Teacher/student/parent Interview:__________________________________________________________________________

Progress Monitoring data:

Behavior: _____________________________________________________________________

Outcome Goal: ____________________________________________________________________________ Date/Data: _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ Behavior: __________________________________________________________________________ Outcome Goal: ____________________________________________________________________________ Date/Data: _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ _____/_____ Areas of Strength:

Most Significant Concern:

How does student data compare to classroom peers?

Have cultural differences been ruled out? Yes_____ No _____ If no, has a SIT Cultural and Linguistic Form been completed? Yes___ No____

Have other medical reasons been rules out? Yes ____ No _____

Functional Behavioral Assessment:

Setting event Antecedent Behavior Consequence

Intervention Checklist (Document any and all interventions and accommodations tried to date):

Accommodations: □ Seating Change □ Additional Time □ Frequent Checks for Understanding □ Positive Verbal Reinforcement □ Peer Mentor/Support □ Reward System (tangible) □ Timer □ Time out in classroom □ Removal from classroom □ Parent Communication

Describe: ____________________ □ Additional Supervision □ Other: ______________________

Research Based Interventions:

Name:

Duration:

Intensity:

Group Size:

Results:

Please attach (if appropriate):

□ Evidence and outcomes of all accommodations □ Functional Behavioral Assessment/Behavior Support Plan □ Point Sheets/Contracts □ Progress Monitoring Graphs □ Behavior Checklists □ Classroom Observations □ IC Data □ Other Important Data □ SWIS

3c


3d


Denver Public School SIT Intervention Plan

To be completed by the Recorder during the SIT Meeting

Student Name:___________________________________ Grade: ______ ID#:_________ DOB: ______ Classroom Teacher: __________________________ School: _______________________ Date:_______ Designated Consultant: _______________________________ Present at the Meeting: _________________________________________________________________ _____________________________________________________________________________________ The purpose of this meeting is to:

1. Identify the problem and its contributing issues and develop a Student Action Plan 2. Determine who will collect the progress monitoring data and intervals for progress monitoring.

*A Follow‐Up Meeting should be scheduled 6‐8 weeks from today. Specific and Observable Description of Student Strengths: Presenting Problem: (Specific, observable, and measurable description of most concerning problem) Data and Evidence: Contributing Issues: (instructional methods/materials, classroom environment, readiness/motivation of student, etc.) Problem Statement and Possible Causes: (Based on the data and contributing issues list 3‐4 possible reasons for the problem. eg. Attendance, poor phonemic/phonetic skills, limited ability to focus)

4a


Denver Public Schools Developing SIT Intervention Plan ( Page 2) Step One: Brainstorm at least 2 solutions to the Primary Problem (What is within the school’s control that will make the biggest impact in the shortest amount of time with existing resources?)

Option 1: Person Responsible: _________________________________________ Starting Date: ___________________ Option 2: Person Responsible: _________________________________________ Starting Date: ___________________ Option 3: Person Responsible: _________________________________________ Starting Date: ___________________ Step 2: Choose which intervention option(s) will be implemented during this intervention cycle.

Option 1 Option 2 Option 3

Step 3: Create a Progress Monitoring Plan (page 5) for each intervention option chosen.

4b


Denver Public Schools SIT Student Intervention and Progress Monitoring Plan

Student Name:________________________________ Grade/Teacher: ________________________ SIT will create a plan to achieve a measurable goal. Progress monitoring data will be collected by the designated person at determined intervals. A Follow‐Up Meeting will be scheduled for 6‐8 weeks from this date. Area of Concern: _____________________________________________________________________________ Measurable Goal (SMART GOAL): _____________________________ will increase ______________________________

as measured by ____________________________________ from _______________ to __________________ by ________________ (date).

Date of Follow‐Up Meeting:_________________ [Be sure to set a date to revisit progress 6 to 9 weeks from today]

Intervention to be Used: _________________________________________________________Frequency:___________________Intensity:_____________________Duration: ____________ Frequency of Data Collection: _____________________________________________________ Assessment Instrument to be Used: ________________________________________________ Person Responsible: _____________________________________________________________

Are additional targeted assessment recommended by SIT? Yes No (Please indicate the targeted assessment to be given, the purpose of the assessment, the trained/qualified person responsible administering the assessment, and have parent sign to give their permission for the assessment to be given.)

Targeted Assessment: ________________________ Purpose: ______________________ Person Responsible: ___________________________

Parent/Guardian Signature giving permission for targeted assessment: ______________________________________ Date: ________________

Targeted Assessment: ________________________ Purpose: ______________________ Person Responsible: ___________________________

Parent/Guardian Signature giving permission for targeted assessment: ______________________________________ Date: ________________

Progress Monitoring Data:

Indicator Dates

By signing below I certify that I understand and agree with the intervention described in this plan and that I have received a copy of the plan. ( Check if interpreter was used) ________________________________________ ______________________________ Parent/Guardian Signature Date

5


Denver Public Schools

SIT FOLLOW‐UP MEETING: Student Name:__________________________ Grade/Teacher: ___________________Date: ____________ Did it Work? (Has the student met the SMART goal demonstrating responsiveness to intervention?)

□ Interventions No Longer Necessary = Have Parent Sign Below □ Continue with Current Intervention = Complete a New Student Intervention and Progress Monitoring Plan (page 5) □ Implement Alternative Intervention = Complete New Student Intervention and Monitoring Plan* (pages 4a, 4b, & 5)

*Consider additional assessment if more information is needed

Notes: By signing below I certify that I understand that my student has made adequate progress (responsiveness to intervention) and at this time does not require additional intervention. ( Check if interpreter was used) _______________________________________________ ______________________ Parent/Guardian Signature Date

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